Assessing the Impact of Transcutaneous Maxillary Distraction Osteogenesis on Pharyngeal Airway Volume in Children with Cleft Lip and Palate: A 3D Evaluation Study.

Cleft lip and cleft palate (CLCP) patients often have a retrusive maxilla and a severe skeletal Class III malocclusion, which can result in velopharyngeal insufficiency (VPI). The aim of this study was to evaluate the changes in the volume of the 3D airway in CLCP children after maxilla distraction using the transcutaneous maxillary distraction osteogenesis (TMDO) method. 15 children with bilateral or unilateral CLCP were included in the study. 3D CBCT images were taken before and after distraction and were segmented and reconstructed to create a 3D airway model. The airway was divided into three regions: the upper, oropharyngeal, and hypopharyngeal airway. Pearson correlation tests were used to assess correlations between volume changes and corresponding skeletal and dental landmark movements (Point N, ANS, A, B, Pog, U1, and L1). The results showed that the ANS point advanced 9.85 ± 3.60 mm, and the A point advanced 14.22 ± 4.57 mm. The total airway volume change increased by 2535.06 ± 2791.80 mm3. However, there was no significant correlation between the A/ANS/U1 and the three different airway regions. Only B/Pog/L1 showed a positive correlation with these airway regions, with a high correlation between B/Pog/L1 and the hypopharyngeal airway region. TMDO can result in greater anterior advancement of the maxilla and an increase in airway volume, but the changes in bony landmarks did not show a strong positive correlation with the increase in airway volume as expected. Further investigation is needed to analyze the influence of surrounding soft tissue on the changes in airway volume.

Prevalence of Dental Anomalies in Taiwanese Children with Cleft Lip and Cleft Palate.

The aim of this study was to investigate the prevalence of tooth agenesis, tooth malformation, and eruption patterns of upper canines/first premolars in Taiwanese children. A total of 132 cleft lip and cleft palate (CLCP) patients (82 boys and 50 girls) underwent alveolar bone grafting (ABG) between 2012 and 2022. The patients' dental records and X-ray images were inspected. We examined dental anomalies, including congenital missing teeth, microdontia, and transposition from the upper canines to the upper first premolars in these CLCP patients. Additionally, we investigated the mean ABG operation age (9.27 ± 0.76 years) of our patient; 40.9% of them received pre-ABG orthodontic treatment at 8.72 ± 0.70 years. Among the 132 cleft subjects, the prevalence of tooth agenesis is 73.5% (97/132). The most frequently missing teeth are the maxillary lateral incisors (right side: 46.2%; left side: 47.0%). In this study, microdontia are found in all the upper incisors, of which the highest percentage (18.9%) is observed in the upper left lateral incisors. The prevalence of upper canine and first premolar transposition is 10.6%. The pattern of tooth agenesis and microdontia of the upper lateral incisors shows a strong correlation with the cleft sites of these CLCP patients in our study. These results may support the idea that the patterns of dental anomalies in CLCP patients are region-specific.

Rejuvenated endothelial progenitor cells through overexpression of cellular prion protein effectively salvaged the critical limb ischemia in rats with preexisting chronic kidney disease.

BACKGROUND: This study tested the hypothesis that overexpression of cellular prion protein in endothelial progenitor cells (PrPcOE-EPCs), defined as "rejuvenated EPCs," was superior to EPCs for salvaging the critical limb ischemia (CLI) induced after 28-day chronic kidney disease (CKD) induction in rat. METHODS AND RESULTS: Cell viability and flow cytometric analyses of early/late apoptosis/total-intracellular ROS/cell cycle (sub-G1, G2/M phase) were significantly higher in EPCs + H2O2 than in EPCs that were significantly reversed in PrPcOE-EPCs + H2O2 (all p < 0.001). The protein expressions of inflammation (IL-1ß/IL-6/MMP-9/p-NF-κB) were significantly increased in EPC + TNF-α than in EPCs that were significantly reversed in PrPcOE-EPCs + TNF-α (all p < 0.001). Adult-male SD rats (n = 8/each group) were categorized into group 1 (sham-operated control), group 2 (CKD + CLI), group 3 [CKD + CLI + EPCs by intravenous (0.6 × 105)/intra-muscular (0.6 × 105) injections at 3 h after CLI induction], group 4 (CKD + CLI + PrPcOE-EPCs/dose-administration as group 3) and group 5 (CKD + CLI + siPrnp-EPCs/dose-administration as group 3). By day 14 after CLI induction, the ratio of ischemia to normal blood flow (INBF) in CLI area was highest in group 1/lowest in group 2/significantly higher in group 4 than in groups 3/5 and significantly higher in group 3 than in group 5 (all p < 0.0001). Histopathology demonstrated that the angiogenesis (number of small vessels/CD31 + cells) exhibited a similar trend, whereas the fibrosis/kidney injury score exhibited an opposite pattern of INBF among the groups (all p < 0.0001). The protein expressions of angiogenesis (SDF-1α/VEGF/CXCR4)/cell-stress signaling (p-PI3K/p-Akt/p-m-TOR) were significantly and progressively increased from groups 1-4 that were reversed in group 5 (all p < 0.0001). The protein expressions of fibrotic (p-Smad3/TGF-ß)/oxidative-stress (NOX-1/NOX-2/oxidized-protein)/apoptotic (mitochondrial-Bax/cleaved caspase3/cleaved PARP)/mitochondrial-damaged (cytosolic-cytochrome-C) biomarkers displayed an opposite pattern of INBF among the groups (all p < 0.0001). CONCLUSION: PrPcOE-EPCs were superior to EPCs only therapy for salvaging the CLI.

Comparison of the Post-Surgical Position of the Temporomandibular Joint after Orthognathic Surgery in Skeletal Class III Patients and Patients with Cleft Lip and Palate.

OBJECTIVE: The purpose of our research is to compare the post-surgical position of the temporomandibular joint in skeletal Class III patients and patients with cleft lip and palate treated with two-jaw orthognathic surgery using a three-dimensional computer tomography image. MATERIALS AND METHODS: Twenty-three skeletal Class III patients with mandibular prognathism associated with maxillary retrognathism in group 1 and twenty cleft mid-face retrusion skeletal Class III patients in group 2 were enrolled in this study. All subjects were treated with two-jaw orthognathic surgery. Computed tomography scans were taken in all subjects at 3 weeks preoperatively and 6 months postoperatively. Three-dimensional craniofacial skeletal structures were build-up, and assessed the temporomandibular joint position changes before and after surgery. RESULTS: Forty-three selected patients were separated into two groups. The mean age of patients was 22.39 ± 4.8 years in group 1 and 20.25 ± 3.8 years in group 2. The range of mean three-dimensional discrepancy of the selected condylar points was 0.95-1.23 mm in group 1 and 2.37-2.86 mm in group 2. The mean alteration of intercondylar angle was 2.33 ± 1.34° in group 1 and 6.30 ± 2.22° in group 2. The significant differences in the discrepancy of TMJ and changes in intercondylar angle were confirmed within the intra-group and between the two groups. CONCLUSIONS: Significant changes in postoperative TMJ position were present in both groups. Furthermore, the cleft group presented significantly more postoperative discrepancy of TMJ and more changes in intercondylar angle after surgery. This finding may be a reason leading to greater postoperative instability in cleft patients compared with skeletal Class III non-cleft patients. CLINICAL TRIAL REGISTRATION NUMBER: IRB No: 202201108B0.

Approaching patients with panfacial fractures by using an anatomical reference: A novel concept and preliminary study.

Panfacial fractures are challenging for craniofacial surgeons. Aside from involving multiple subunits, they also lack the reliability of a useful landmark of the facial skeleton. Properly, reducing and fixing palatal fracture to re-establish the premorbid maxillary dental arch is important. This was a retrospective study conducted from 2015 to 2020. All patients underwent computed tomography (CT) scan for surgical planning of orthognathic surgery due to either esthetic or occlusion concerns. The classification of occlusion was recorded as class I, II, and III. The parameters measured on CT were the distance between the midpoint of the supra-orbital foramen/notch (IS), mesio-buccal cusp tips (IB), central fossa (IC), palatal cusp tips (IP), and the midpoint of the palatal marginal gingiva (IM) of the bilateral maxillary first molars. The IS was compared with the IB, IC, IP, and IM. The results were analyzed by using one-way repeated measurement analysis of variance. Eighty-seven patients (36 men and 51 women) were included in the study. There were 13 patients of class I malocclusion, 8 of class II malocclusion, and 66 of class III malocclusion. The IS was comparable to the IC in all three groups. The IS can predict the IC, regardless of the patient's occlusion, and can be subsequently used to decide the width of maxillary dental arch in panfacial fracture management. Further studies are necessary to obtain more definite results.

A Comparative Study of Skeletal and Dental Outcome between Transcutaneous External Maxillary Distraction Osteogenesis and Conventional Rigid External Device in Treating Cleft Lip and Palate Patients.

BACKGROUND: Traditional distraction osteogenesis (DO) with the tooth-borne rigid external device (RED) system was regularly used in treating patients with cleft-related maxillary hypoplasia. However, the bone-borne RED system with miniplates and bone screws has currently become an effective treatment. This retrospective study was to compare bone-borne RED with traditional tooth-borne RED in distraction effectiveness, blood loss, operative time, and long-term stability. METHODS: Twenty-two growing patients who underwent RED therapy were divided into two groups: eleven patients utilizing the bone-borne RED system with the transcutaneous wire attached with skeletal anchorage; another eleven patients using the traditional tooth-borne RED system with the intra-oral device attached with dental anchorage. Serial lateral cephalograms were analyzed for comparing treatment outcomes and stability in 1 month, 6 months, and 1.5 years after distraction. RESULTS: In bone-borne RED group, the maxilla was advanced by 19.98 mm with slight clockwise rotation of 0.40° and minimal palatal inclination change of incisor by -3.94°. In traditional tooth-borne RED group, the maxilla showed less advancement by 14.52 mm, with significant counter-clockwise rotation of -11.23° and excessive palatal inclination change of incisor by -10.86°. Although operative time was longer in the bone-borne RED group by 38.4 min, this did not bring about greater blood loss. CONCLUSIONS: the bone-borne RED via transcutaneous wire system provides an easy, simple, and comfortable procedure as well as favorable long-term stability in maxillary distraction.

The Predictability of the Surgical Outcomes of Class III Patients in the Transverse Dimension-A Study of Three-Dimensional Assessment.

This study aimed to assess the outcomes of planned maxillary surgical movements in the transverse direction in patients possessing a Class III skeletal pattern. The available consecutive patients' records were retrospectively reviewed. Only those possessing a Class III skeletal pattern, and for whom the same virtual planning system was used, were enrolled. The waferless technique was used to guide the jawbone repositioning. A representative triangle in the virtual maxilla of each stage was used to validate the planned surgical movements (PSMs) and the outcome discrepancy (OD). The linear and angular measurements were retrieved for the assessments of the correlation between PSM and OD. In total, 44 adult patients who met the inclusion criteria were studied. The average linear OD of the A-point in the transverse direction was 0.66 ± 0.54 mm, and the yaw correction showed 1.02 ± 0.84 degrees in difference. There was no specific correlation between the linear PSMs and ODs; however, the angular ones were positively correlated. With the help of the waferless technique to transfer the virtual planning results, the practitioners could confidently predict the postsurgical maxillary position in the transverse direction in the orthognathic surgery of Class III patients. However, the yaw correction should be carefully planned to avoid postsurgical instabilities.

Repairing Facial Fractures with Interrupted Maxillary-mandibular Arches by Computer-assisted Reverse Planning Model Surgery.

BACKGROUND: Management of comminuted facial fractures with maxillary-mandibular arch interruption is difficult, resulting in inadequate bone reduction and malocclusion. Traditionally, a good quality dental splint is helpful, but difficult to obtain in acute trauma. We apply a computer-assisted design and three-dimensional printing technology to improve splint fabrication and utilization, thus facilitating restoration of dental occlusion and facial fracture. METHODS: We retrospectively reviewed patients who suffered from facial fractures with interruption of the maxillary-mandibular arches. We developed the "computer-assisted reverse planning and three-dimensional printing model surgery" algorithm and applied it in selected patients. An occlusal splint was created as a surgical guide to enhance the maxilla-mandibular unit repair by taking care of the bone reduction and occlusion. All included patients were followed up to assess the functional outcome and patients suitable for this method. RESULTS: From Jan 2015 to Aug 2020, 10 patients (eight men and two women) with comminuted facial fractures were included. The average time of surgery was 9.2 days. The average follow-up time was 8.6 months. There was no patient who needed major revision to correct malocclusion or facial asymmetry. CONCLUSIONS: A computer-assisted design splint decreases intraoperative inaccuracies and difficulty in comminuted maxillo-mandibular fractures. It is a useful and reliable alternative. Collaboration with an experienced engineer and patient selection are indispensable in delivering successful outcomes. Patients who have more than three bone fragments in a single dental arch or more than four bone fragments in the entire maxillary-mandibular unit appear to be excellent candidates for this method.

One-Year Treatment Outcome of Profile Changes After Transcutaneous Maxillary Distraction Osteogenesis in Growing Children With Cleft Lip and Palate.

OBJECTIVE: To evaluate the long-term stability of LeFort I osteotomy followed by distraction osteogenesis with a transcutaneous rigid external device for the treatment of severe maxillary hypoplasia in patients with cleft lip and palate. PATIENTS AND METHODS: Nine patients with cleft lip and palate underwent rigid external distraction after a LeFort I osteotomy for maxillary advancement. Lateral cephalometric films were analyzed for assessment of treatment outcome and stability in 1 month, 6 months, and 1 year after distraction. RESULTS: Significant maxillary advancement was observed in the horizontal direction, with the anterior nasal spine (ANS) distance of the maxilla increasing by an average of 20.5 ± 5.1 mm after distraction. The ANS relapse rates in 6 months and 1 year were 8.7% and 12.8%, respectively. The mean inclination of upper incisors to the palatal plane was almost unchanged (before: 109.8° ± 6.6°; after: 108.9° ± 7.5°). The movement ratios at the nasal tip/ANS, soft tissue A point/A point, and the upper vermilion border/upper incisor edge were 0.36:1, 0.72:1, and 0.83:1, respectively. CONCLUSION: Considerable maxillary advancement was achieved with less change of incisors inclination after distraction. Moreover, the relapse rate after 1 year was minimal. The concave facial profile was improved as well as the facial balance and aesthetics.

Three-Dimensional Outcome Assessments of Surgical Correction in Cleft and Noncleft Patients with Class III Skeletal Relation: A Case-Control Study.

BACKGROUND: The orthognathic strategies to treat patients with a concave profile but different tissue conditions remain controversial. The aim of this case-control study was to investigate the outcome predictability of orthognathic surgery in cleft lip and palate (CLP) patients and matched controls. METHODS: Fifty consecutive CLP and 45 matched non-CLP patients who received whole-piece Le Fort I and bilateral sagittal split osteotomy to correct class III skeletal relations were enrolled. The outcome discrepancies (ODs) from simulations among all groups were evaluated with consideration of the possible influences from planned surgical movements (PSM). Receiver operating characteristic curves were used to determine threshold values of PSMs that yielded clinically relevant OD. RESULTS: Unilateral CLP (UCLP) patients had comparable postsurgical OD to non-CLP patients in both jaws, whereas bilateral CLP (BCLP) patients had greater deviations from predicted results. Vertical movement of the A - point > 1.33 mm and yaw correction > 1.65° in the BCLP patients was associated with clinically relevant maxillary OD. CONCLUSIONS: The OGS outcomes of BCLP patients were less predictable than those of the UCLP and noncleft patients. Vertical movements of the A - point > 1.33 mm and yaw correction > 1.65° in BCLP patients increased OD to a clinically relevant extent.

Postsurgical Stability of Temporomandibular Joint of Skeletal Class III Patients Treated with 2-Jaw Orthognathic Surgery via Computer-Aided Three-Dimensional Simulation and Navigation in Orthognathic Surgery (CASNOS).

OBJECTIVE: The aim of this study is to clarify the postsurgical stability of temporomandibular joints in skeletal class III patients treated with 2-jaw orthognathic surgery which was performed utilizing computer-aided three-dimensional simulation and navigation in orthognathic surgery (CASNOS) protocol. MATERIALS AND METHODS: 23 consecutive nongrowing skeletal class III patients with mandibular prognathism associated with maxillary retrognathism treated with 2-jaw orthognathic surgery between 2018 and 2019 were enrolled in this study. The surgery was planned according to the standardized protocol of CASNOS (computer-aided three-dimensional simulation and navigation in orthognathic surgery). Computed tomography (CT) scans were performed in all patients 3 weeks presurgically and 6 months postsurgically. ITKSNAP and 3D Slicer software were used to reconstruct three-dimensional facial skeletal images, to carry out image segmentation, and to superimpose and quantify the TMJ position changes before and after surgery. Amount of displacement of the most medial and lateral points of the condyles and the change of intercondylar angles were measured to evaluate the postsurgical stability of TMJ. RESULTS: A total amount of 23 skeletal class III patients (female : male = 12 : 11) with age ranged from 20.3 to 33.5 years (mean: 24.39 ± 4.8 years old) underwent Le Fort I maxillary advancement and BSSO setback of the mandible. The surgical outcome revealed the satisfactory correction of their skeletal deformities. The mean displacement of the right most lateral condylar point (RL-RL') was 1.04 ± 0.42 mm and the mean displacement of the left most lateral condylar point (LL-LL') was 1.19 ± 0.41 mm. The mean displacement of the right most medial condylar point (RM-RM') was 1.03 ± 0.39 mm and the left most medial condylar point (LM-LM') was 0.96 ± 0.39 mm. The mean intercondylar angle was 161.61 ± 5.08° presurgically and 159.28 ± 4.92° postsurgically. CONCLUSION: The postsurgical position of TM joint condyles in our study only presented a mild change with all the landmark displacement within a range of 1.2 mm. This indicates the bimaxillary orthognathic surgery via 3D CASNOS protocol can achieve a desired and stable result of TMJ position in treating skeletal class III adult patients with retrognathic maxilla and prognathic mandible.

Velar Closing Ratio As a Predictor for the Verlopharyngeal Function After Double Opposing Z-Plasty for Postpalatoplasty Velopharyngeal Insufficiency in Patients With Cleft Palate.

BACKGROUND: This study was designed to identify the potential predictors of postoperative velopharyngeal function after double opposing Z-plasty (DOZP) for the treatment of velopharyngeal insufficiency (VPI) in patients who had prior palatoplasty for cleft palate. METHODS: This retrospective study reviewed the medical records of consecutive patients who received DOZP for VPI after receiving a prior palatoplasty treating cleft palate between 2004 and 2017. The speech outcome of patient was measured using the Pittsburgh Weighted Speech Scale (PWSS) at 6 months following surgery and determined the outcome suggests velopharyngeal competence (PWSS ≤2) or incompetence (PWSS >2). Stepwise logistic regression was used to identify the variables for the prediction of competent surgical outcome. The specific receiver operating characteristic curves with an area under the curve (AUC) was used to evaluate the predictor related to the surgical outcome as competence. RESULTS: The study included 93 patients. Age, relative velar length, velar lengthening, and closure pattern were not significantly associated with postoperative competence status of the patient. The only variable that predicted a successful surgical outcome was preoperative velar closing ratio. However, the accuracy of velar closing ratio in predicting a competent surgical outcome is only moderate (AUC = 70.37). CONCLUSION: The results of this study showed that preoperative velar closing ratio may predict, with moderate accuracy, a successful surgical outcome in patients with postpalatoplasty VPI who undergo DOZP. Therefore, in patients with a low preoperative velar closing ratio, some alternative surgical methods other than DOZP may be considered to avoid unsatisfactory surgical outcome.

Accuracy assessment of computer-aided three-dimensional simulation and navigation in orthognathic surgery (CASNOS).

PURPOSE: This study is aimed for measuring the accuracy of simulation and prediction of our CASNOS protocol in adult patients treated with 2-jaw orthognathic surgery. METHODS: Adult patients with skeletal Class III malocclusions requiring 2-jaw orthognathic surgery were enrolled in the study. Three-dimensional imaging data of 1-month pre-surgical (T1) and 6-month post-surgical (T2) CT were compared to assess accuracy of CASNOS planning. The accuracy of CASNOS protocol was evaluated by calculating the differences in the positions of selected landmarks between simulated surgical and post-surgical 3D images parameters, including ANB, A-Nv, Pog-Nv, and the positions of selected landmarks (ANS, Point A, Point B, Pog) changes in horizontal (x-axis) and vertical (y-axis) directions. Overall geographical discrepancy of planning was assessed by superimposing the color mapping of T1 and T2 imaging. RESULTS: Thirty adult patients with a mean age of 20.6 ± 1.5 years (female/male = 18/12) were enrolled. The geographical changes of overall superimposition between the planned and post-surgical imaging was 0.60 ± 0.19 mm (range: 0.42-1.08 mm). The discrepancies between simulated and post-surgical ANB, A-Nv, Pog-Nv were 1.16 ± 0.36°, 1.25 ± 0.33 mm, 1.19 ± 0.35 mm, respectively. The deviations between simulated and post-surgical Point A and Point B positions were within 1 mm in horizontal and vertical directions. CONCLUSION: The application of the pre-designed bony guiding splints of CASNOS protocol can allow surgeons to treat patients with craniofacial deformities precisely. CASNOS provides a novel approach for orthodontists and surgeons accurately remedying the patients with complex craniofacial discrepancies.

Three-Dimensional Outcome Assessments of Cleft Lip and Palate Patients Undergoing Maxillary Advancement.

BACKGROUND: The aim of this retrospective case series study was to compare three-dimensional postsurgical outcomes of patients with cleft lip and palate following maxillary advancement. METHODS: Fifty consecutive cleft lip and palate patients who underwent whole-pieced Le Fort I advancements were assigned to the major (advancement ≥ 5 mm) or minor (advancement < 5 mm) groups. Three-dimensional surgical simulation was used for presurgical evaluation and planning. Virtual triangles of the presurgical, simulated, and 6-month postoperative stages were used for comparison. Translational and angular changes of each endpoint (A-point, MxR, and MxL) on the virtual triangles and reference planes were recorded and analyzed. Relationships between possible related variables and outcome discrepancies from simulations among all subgroups were also investigated. RESULTS: Analysis of covariance and the least significant difference test revealed that the outcome discrepancy measurements were affected by different combinations of independent variables. The reliability test showed high consistency of the authors' method for three-dimensional measurements. CONCLUSIONS: The actual surgical outcomes of cleft lip and palate patients differed from the virtual simulations. The outcome discrepancies are impacted by multiple factors. The outcome discrepancies of all rotational surgical corrections (roll, yaw, and pitch) were positively correlated to the degree of planned surgical movement. Meanwhile, bilateral cleft lip and palate patients are more likely to incur outcome discrepancies in yaw correction with major maxillary advancement. However, a maxillary advancement cutoff value of 5 mm would not necessarily lead to significant translational outcome discrepancies among cleft lip and palate patients. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Prognostic Factors for Hearing Outcomes in Children with Cleft Lip and Palate.

BACKGROUND: This study was performed to investigate the prognostic factors that influence hearing outcomes of children with cleft lip and palate after ventilation tube insertion. METHODS: The authors retrospectively reviewed the hearing thresholds of 90 children with cleft lip and palate and performed univariate and multivariate analyses of five prognostic factors for hearing outcomes: age at palatoplasty, age at first ventilation tube insertion, timing of ventilation tube insertion, frequency of ventilation tube insertion, and type of cleft palate. RESULTS: On univariate analysis, the authors found that older age at palatoplasty (p = 0.002), older age at first ventilation tube insertion (p = 0.025), and increased frequency of ventilation tube insertion (p = 0.048) were significant prognostic factors for poorer hearing outcomes in children with cleft lip and palate. Multiple logistic regression analysis showed that late palatoplasty (age older than 1 year) was the most influential factor for poor hearing outcome (OR, 2.83), followed by two or more ventilation tube insertions (OR, 1.94). CONCLUSION: The age at palatoplasty and frequency of ventilation tube insertion were found to be significant prognostic factors influencing hearing outcomes in children with cleft lip and palate. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.

Blood loss and operative time associated with orthognathic surgery utilizing a novel navigation system in cleft lip and palate patients.

PURPOSE: This retrospective study evaluated the volume of blood loss and operative time associated with management of nongrowing patients with cleft lip and palate (CLP) using bimaxillary orthognathic surgery (OGS) designed by a three-dimensional (3D) computer-assisted simulation and navigation for orthognathic surgery (CASNOS) system. METHODS: This study included 53 skeletal Class III nongrowing patients with unilateral CLP who underwent bimaxillary OGS using either the CASNOS protocol (n = 30) or the traditional two-dimensional (2D) method (n = 23). The skeletal parameters of jaw-bone components, the levels of hemoglobin (Hb) and hematocrit (Hct) were measured before and after surgery. The estimated blood loss and actual blood loss (ABL) were also calculated. RESULTS: The two groups did not differ significantly with regard to the demographic parameters (age, gender, and body mass index), the preoperative skeletal parameters and surgical changes of jaw-bone components. The mean ABL of the CASNOS group was significantly lower than that of the control group (915.6 ± 280.5 vs. 1204.9 ± 201.0 ml, p < 0.001), and the changes in Hb and Hct level also followed a similar pattern in both groups. The mean operative time was significantly shorter in the CASNOS group compared with the control group (384.2 ± 48.5 vs. 469.0 ± 94.9 min, p < 0.001). CONCLUSION: This study demonstrated that the application of the 3D CASNOS approach in OGS for the management of complicated Class III nongrowing patients with CLP significantly shortened the operative time and reduced ABL in comparison with the traditional 2D methods.

Use of Nasal Conformer After Birth Effectively Improves Nostril Symmetry in Patients With Unilateral Incomplete Cleft Lip.

PURPOSE: To investigate the clinical effects of preoperative nasoalveolar molding (NAM) and nasal conformer use in patients with unilateral incomplete cleft lip on the basis of their medical records and images. PATIENTS AND METHODS: Data and images of 16 patients born with unilateral incomplete cleft lip who were hospitalized between January 2015 and August 2017 were retrieved from the medical records. The primary outcome was the extent of improvement in columella height (CH) before cheiloplasty. Other outcome measurements included the CH, nostril width, and nostril height, which were measured by ImageJ image processing software (version 1.4; National Institutes of Health, Bethesda, MD) and presented as ratios. Mann-Whitney U tests were used to compare the non-normally distributed data. RESULTS: Patients in the NAM group and those in the nasal conformer group showed significantly improved (P < .05) preoperative cleft-side CH-to-normal-side CH ratios compared with the corresponding ratios at birth. There was no significant difference in terms of the extent of improvement in CH between the groups. CONCLUSIONS: Preoperative use of nasal conformers in patients with unilateral incomplete cleft lip not only corrects the deformed nasal cartilage but also increases the CH and improves the overall preoperative nasal symmetry. In addition, compared with NAM, this method costs less, is more straightforward, and requires fewer outpatient clinic visits.

Epignathus teratoma with duplication of mandible and tongue: report of a case.

We report a female infant with presentation of epignathus teratoma involving duplication of both the mandible and tongue. Epignathus with duplication of the mandible has rarely been reported in the literature thus far. The location and extent of the tumor, as well as the involvement of adjacent structures, resulted in trismus and upper airway obstruction at birth. Thus, staged operations including debulking and correction of anatomical anomaly were performed on this patient after life-saving tracheostomy. As a result, we not only prevented morbidity associated with the anomaly but also refined the patient's appearance and improved her quality of life.

Traumatic superior orbital fissure syndrome: assessment of cranial nerve recovery in 33 cases.

BACKGROUND: Superior orbital fissure syndrome is a rare complication that occurs in association with craniofacial trauma. The characteristics of superior orbital fissure syndrome are attributable to a constellation of cranial nerve III, IV, and VI palsies. This is the largest series describing traumatic superior orbital fissure syndrome that assesses the recovery of individual cranial nerve function after treatment. METHODS: In a review from 1988 to 2002, 33 patients with superior orbital fissure syndrome were identified from 11,284 patients (0.3 percent) with skull and facial fractures. Severity of cranial nerve injury and functional recovery were evaluated by extraocular muscle movement. Patients were evaluated on average 6 days after initial injury, and average follow-up was 11.8 months. RESULTS: There were 23 male patients. The average age was 31 years. The major mechanism of injury was motorcycle accident (67 percent). Twenty-two received conservative treatment, five were treated with steroids, and six patients underwent surgical decompression of the superior orbital fissure. After initial injury, cranial nerve VI suffered the most damage, whereas cranial nerve IV sustained the least. In the first 3 months, recovery was greatest in cranial nerve VI. At 9 months, function was lowest in cranial nerve VI and highest in cranial nerve IV. Eight patients (24 percent) had complete recovery of all cranial nerves. Functional recovery of all cranial nerves reached a plateau at 6 months after trauma. CONCLUSIONS: Cranial nerve IV suffered the least injury, whereas cranial nerve VI experienced the most neurologic deficits. Cranial nerve palsies improved to their final recovery endpoints by 6 months. Surgical decompression is considered when there is evidence of bony compression of the superior orbital fissure.